These efforts to improve and measure communication
skills are timely, as the barriers to effective communication
between patients and physicians are growing (Figure 1). Despite
evidence indicating that the average length of the patientphysician
encounter has not changed significantly in recent
years,9 specific survey data indicate a correlation between
patient participation in capitated health plans and shorter
office visits. Further, hurdles arising from linguistic and
cultural differences, already abundant, will only increase in
coming years. Medical information and support groups
found on the Internet, while potentially a great asset in educating
and motivating patients toward better health, have
many physicians questioning their traditional role as most
trusted counselors. However, even demands associated
with time, language, and technology––as Internet-available
information, which potentially limits face-to-face opportunities––
are not an excuse for neglecting one’s communication
skills. During the typical 15- or 20-minute patient-physician
encounter, the physician makes nuanced choices regarding
the words, questions, silences, tones, and facial expressions
he or she chooses. These choices either enhance or detract
from the overall level of excellence of the physician’s delivery
of care.